1. Field of the Invention
The present invention pertains to medical procedures and instruments and, more particularly, to a system for anchoring a cannula in an anatomical cavity wall.
2. Discussion of the Prior Art
Endoscopic and minimally invasive medical procedures are widely used for surgical and diagnostic treatment and viewing in an anatomical cavity and generally utilize a cannula, such as portal sleeve, inserted through a wall of the anatomical cavity to provide a passage for introduction of instruments into the cavity. In many endoscopic procedures, access to the anatomical cavity is gained by utilizing a penetrating instrument composed of a penetrating member, such as a trocar or obturator, within a portal sleeve to penetrate the wall of the cavity with the penetrating member thereafter withdrawn leaving the portal sleeve in place to establish a portal for introducing instruments into the anatomical cavity. The portal sleeve typically has a proximal end disposed externally of the anatomical cavity and coupled with a portal housing mounting a valve and sealing arrangements allowing the penetrating member and other instruments to be inserted into and removed from the sleeve while preventing leakage of fluids from the anatomical cavity. The portal sleeves are subject to longitudinal and angular movement during the procedures due to the movement of instruments therethrough and the manipulation of the instruments within the cavity particularly since the instruments are sealingly engaged along the portal sleeve particularly at the housing. It has, thus, become important to securely anchor the portal sleeve to the cavity wall and to stabilize the portal sleeve in a desired angular orientation relative to the cavity.
Many anchoring and/or stabilizing devices are available and, typically, utilize arrangements such as expandable devices in the form of inflatable balloons, mechanically hinged legs or mechanically or pneumatically expandable members for contacting, in an expanded state, an internal surface of the cavity wall and/or members for contacting and/or sealing an external surface of the cavity wall as exemplified by U.S. Pat. No. 3,039,648 to Price, U.S. Pat. No. 3,253,594 to Matthews et al, U.S. Pat. No. 3,817,251 to Hasson, U.S. Pat. No. 3,952,742 to Taylor, U.S. Pat. No. 5,002,557 to Hasson, U.S. Pat. No. 5,073,169 to Raiken, U.S. Pat. No. 5,122,122 to Allgood, U.S. Pat. No. 5,137,520 to Maxson et al, U.S. Pat. No. 5,147,316 to Castillenti, U.S. Pat. No. 5,176,648 to Holmes et al, U.S. Pat. No. 5,176,697 to Hasson et al, U.S. Pat. No. 5,203,773 to Green, U.S. Pat. No. 5,215,531 to Maxson et al, U.S. Pat. No. 5,217,451 to Freitas, U.S. Pat. No. 5,232,451 to Freitas et al, U.S. Pat. No. 5,234,455 to Mulhollan, U.S. Pat. No. 5,263,939 to Wortrich, U.S. Pat. No. 5,267,970 to Chin et al, U.S. Pat. No. 5,273,545 to Hunt et al, U.S. Pat. No. 5,257,975 to Foshee, U.S. Pat. No. 5,279,564 to Taylor, U.S. Pat. No. 5,279,575 to Sugarbaker, U.S. Pat. No. 5,284,474 to Adair and U.S. Pat. No. 5,290,249 to Foster et al. Additionally, spiral threads or other protrusions carried by a cannula for engaging a cavity wall along the thickness thereof have been proposed as exemplified by U.S. Pat. No. 4,655,752 to Honkanen et al, U.S. Pat. No. 5,009,643 to Reich et al, U.S. Pat. No. 5,217,441 to Schichman, U.S. Pat. No. 5,226,890 to Ianniruberto et al, U.S. Pat. No. 5,248,298 to Bedi et al, U.S. Pat. No. 5,258,003 to Ciaglia et al, U.S. Pat. No. 5,271,380 to Rick et al and U.S. Pat. No. 5,273,545 to Hunt et al, and the Endopath Adjustable Stability Threads sold by Ethicon Endo-Surgery. Other anchoring and/or stabilizing devices, such as those described in U.S. Pat. No. 5,257,973 to Villasuso, have attempted to maintain the position of the portal sleeve during the procedure by attaching hooks or clamps to the cannula and using a length of suture material to tie the hooks or clamps to a patient's body tissue. U.S. Pat. No. 4,985,033 to Boebal et al is representative of devices for sealing openings used in open laparoscopy and for fixing fascial holding sutures.
Additionally, in other medical procedures, it is important to securely anchor cannulas, such as catheters, in place in anatomical cavity walls to provide a portal for access to the cavity to allow passage for instruments and/or fluids. The anchoring must be accomplished in as safe and non-traumatic manner as possible, and anchoring in a cavity wall such as that of an internal organ must be precisely accomplished in a simple manner to facilitate use and permit readjustment at surgical sites which are easily accessible or are difficult to access, such as in endoscopic or minimally invasive procedures.
The use of tissue penetrating members has been suggested for use in devices to hold needles and catheters in place on a patient, as exemplified by U.S. Pat. No. 2,670,735 to Brody and U.S. Pat. No. 4,164,943 to Hill et al; however, such devices cannot be used to anchor cannulas passing substantially transversely through a cavity wall and the devices.
The above discussed anchoring and/or stabilizing devices have the disadvantages of being difficult to use in securely angularly orienting cannulas and reorienting the cannulas during a procedure, of not adequately grasping an anatomical cavity wall to permit manipulation or lifting of the wall due to all of the lifting or manipulating force being applied to the internal surface of the wall, e. g. the peritoneum in the case of laparoscopy, of frequently requiring resetting or reanchoring and/or of being time consuming and difficult to use.